Objective To investigate the therapeutic effect of Qingre Bawei capsules combined with entecavir on initial diagnosed bacterially-positive pulmonary tuberculosis patients with chronic hepatitis B (CHB). Methods A total of 106 patients with initial diagnosed of pulmonary tuberculosis and CHB, admitted to the Chest Hospital affiliated to Hunan Normal University/Hunan Provincial Chest Hospital from August 2021 to August 2022, were randomly divided into two groups, with 53 cases in each group. Both groups were treated with anti-tuberculosis drugs, while the control group was treated with entecavir, and the observation group was treated with Qingre Bawei capsules combined with entecavir. The clinical efficacy was compared between two groups, as well as changes in liver function [aspartate aminotransferase (AST), total bilirubin (TBil), alanine aminotransferase (ALT)], lung function [diffusing capacity of the lungs for carbon monoxide (DLCO), total lung capacity (TLC), percentage of measured forced expiratory volume in one second to predicted value (FEV₁%), lung capacity (VC)], hepatitis B virus (HBV)-DNA load, T helper cell (Th) 1/Th2 cytokines [Interferon-γ (IFN-γ), interleukin-2 (IL-2), interleukin-4 (IL-4)], and serum transforming growth factor-β1 （TGF-β1） levels before and after treatment. Results The total effective rate of the observation group after 6 months of treatment was 94.34%, which was higher than that of the control group's 73.58%. After 6 months of treatment, the levels of serum ALT, AST, TBil, IL-4, and TGF-β1 as well as the HBV-DNA load in the observation group were decreased compared to the control group, while the levels of IFN-γ and IL-2 were increased compared to the control group. After 6 months of treatment, there was no significant difference in the levels of TLC, DLCO, FEV1%, and VC between the observation group and the control group. The incidence of liver damage in the observation group was 7.55%, which was lower than that in the control group's 30.19%. The incidence of adverse reactions in the observation group was 20.75%, which was not significantly different from the control group's 30.19%. Conclusion The Qingre Bawei capsule, in combination with entecavir, demonstrates a reliable therapeutic effect in treating tuberculosis combined with CHB. It can reduce the HBV-DNA load, improve liver function, and enhance the Th1/Th2 immune balance in patients.